What questions do CQC ask care staff?

We know the way that the CQC inspect care services is due to change and take a more digital approach. However, one thing that will not change is the feedback from people who use those care services, their families and representatives, and staff.  

In this week’s blog post, I explore some of the questions that the CQC may ask your staff during inspections.

Preparing your care staff for CQC inspections

First thing’s first, we need to ensure that our teams understand that inspections are a natural part of the regulator’s role. In order to do this, you should ensure that:

• The inspectorate is on team meeting agendas
• Staff are aware of inspection processes
• You undertake mock inspections and involve staff, so that when it comes to the real inspection, staff feel at ease and are primed and ready to be involved.  

CQC questions

The CQC website documents the focus points that the inspector will be interested in.  

Below are 13 focus points, with additional questions to help you get a better idea of what they’ll be asking – and prepare for how you might answer them.

1. How do systems, processes and practices safeguard people from abuse?

• How are you managing risks to safeguard people from abuse?
• How are you protecting people’s human rights, including consent about health treatment, particularly about involvement in advance care plans / DNACPR decisions?
• What are your arrangements to ensure people receive timely care that respects their dignity?
• What action are you taking to ensure people who use the service are protected from abuse, and to support them to understand their rights?
• How do you assure yourself that staff report concerns immediately and appropriately to the right person/people?

2. How are risks to people assessed – and how is their safety monitored and managed – so they are supported to stay safe, and their freedom is respected?

• How do you assess and review risks to people, to ensure you monitor them?
• What arrangements are there to manage risks appropriately, and to make sure that people are involved in decisions about any risks they may take?
• How do you share information about risks with staff, people using your service and visitors?
• How do you ensure staff, people using your service and visitors understand the arrangements (for example, signage, accessible information, information on your website)?
• What lessons have you learned, or actions have you taken, to reduce or minimise the risk of accidents and incidents from happening in the future?

3. How does the service make sure that there are sufficient numbers of suitable staff to support people to stay safe and meet their needs?

• How has the pandemic affected your ability to staff the service, including their management, safety, wellbeing and deployment? For example, have you used agency staff?
• What action have you taken to manage this and ensure you continue to meet people’s needs?
• How have you been able to make sure people get care and support from workers with the right knowledge and skills?
• Are working arrangements clear and accessible to staff, people who use the service, their supporters and visitors?

4. How do you ensure the proper and safe use of medicines?

• How have you ensured that the right medicines in the right doses and quantities are available to people, at all times?
• How have you ensured medicines are stored and transported safely? For example, how are they delivered to the home, any returns?
• How have you ensured any errors are noted, addressed and learned from? Have you any examples?
• How have you ensured people who administer their own medicines can continue to do so safely?
• How do you ensure staff are competent to administer medicines safely? Have staff been asked to complete delegated duties in relation to medicines and was training provided?
• How have you managed any challenges when working with your local healthcare professionals, including community pharmacies?

5. How well are people protected by the prevention and control of infection?

• How have you reviewed and developed your IPC arrangements in response to the pandemic – have you made any changes?
• How are you thoroughly assessing and managing infection risks to people using the service so that the service can provide care to people both with and without coronavirus (COVID-19) symptoms or confirmed diagnoses?
• How effective are your resources to obtain and access all necessary supplies, personal protective equipment and coronavirus testing, for both staff and people using the service?
• What changes have you made to staff working practices, for example, changing facilities, break times, meals and drinks?
• How is IPC-related training and support being provided?

6. How do you ensure consent to care and treatment is always sought in line with legislation and guidance?

• How are you managing social distancing, and ensuring least restrictions on people’s liberty or using seclusion/segregation during the pandemic period?
• How does the service promote supportive practice that avoids the need for physical restraint? For example, are positive behaviour support plans in place? Are staff trained in this?
• Where physical restraint may be necessary, how do you ensure that it is used in a safe, proportionate, and monitored way as part of a wider person-centred support plan?
• How are you ensuring that you continue to meet Mental Capacity Act Code of Practice requirements?

7. How do you ensure that people are treated with kindness, respect and compassion, and that they are given emotional support when needed?  

• How are people treated with kindness and compassion in their day-to-day care and support?
• How do staff show they know and respect the people they are caring for and supporting, including their preferences, personal histories, backgrounds and potential?
• How are you supporting staff, relatives, and people who use the service to raise any concerns and give feedback?
• How have you supported people’s emotional wellbeing to maintain important relationships, including family / friends / advocates visits?
• How have you supported people to adjust to changes and restrictions to their social life and routines due to coronavirus? What has worked well in supporting people’s emotional and spiritual needs during coronavirus; and how will learning be embedded?

8. How does the service support people to express their views and be actively involved in making decisions about their care, support and treatment as far as possible?

• How do staff recognise when people need and want support from their carers, advocates or representatives to help them understand and be involved in their care, treatment and support?
• Does the service give staff the time, training and support they need to provide care and support in a compassionate and personal way? Are rotas, schedules and practical arrangements organised so that staff have time to listen to people, answer their questions, provide information, and involve people in decisions?

9. How do people receive personalised care that is responsive to their needs?  

• How does the service meet the Accessible Information Standard?
• What impact has the increased use of PPE had on people’s ability to access information for example, hearing impairments?
• How do you ensure that you make other reasonable adjustments for disabled people?
• How do you ensure that you can meet the range of individual needs for people using the service, for example cultural or religious needs?
• How have you changed the way people’s care has been planned since the start of the pandemic?
• How has people’s involvement, or those who are involved in their decision making, been affected by coronavirus?
• How well do people using the service know how to make a complaint or raise concerns?
• How comfortable do they feel to do so in their own way; and how confident are they to speak up?
• How easy and accessible is it for people to use the complaints process or raise a concern?
• How are people who raise a complaint or concern protected from harassment, discrimination or disadvantage?

10. How are people supported at the end of their life to have a comfortable, dignified and pain-free death?

• What, if any, changes have you made to arrangements for supporting people at the end of their lives? In relation to family and friends, and working in partnership with health care professionals?

11. How does the governance framework ensure that responsibilities are clear, and that quality performance, risks, and regulatory requirements are understood and managed?

• How are you supporting services to ensure safe care and treatment is maintained for people during the coronavirus pandemic?
• What are the arrangements to ensure transparency with staff, people using the service and their representatives about coronavirus risks, infections, other safety risks, and deaths?
• Is there a registered manager at the service? Where there is no registered manager, how has the service been managed?
• How are you meeting all relevant legal requirements, including CQC registration requirements, safety and public health obligations and sending notifications?
• How are you keeping up to date with, for example, changes to guidance?
• What support networks have you created/accessed and how have they supported your service?
• Do you have a current certificate(s) of insurance for your service covering both public and employer liability? (It is worth noting, that if you do not have one, the regulator will want to know why.)
• Does the current liability insurance cover include any exclusions or caps in relation to coronavirus or any other issues?
• If the certificate end date shows the policy is due for renewal shortly, have you already discussed this with your insurance provider? Has this raised any concerns about the new cover?
• If you have any concerns about renewing your liability insurance, have you discussed this with your trade association? (if a member)

12. How does the service continuously learn, improve, innovate and ensure sustainability?

• What are your systems and methods for monitoring the overall quality of the service and for responding to business risks and issues as they arise? For example, quality assurance, information and clinical governance systems and evaluating learning from current performance?
• How do you use these systems to drive improvement and manage future performance?
• What have you learned during coronavirus? What learning and improvement has had positive impact for people and/or staff? Do you have examples where coronavirus has led to innovation?

13. How does the provider work in partnership with other agencies?  

• How well are you able to work effectively with system partners when care and treatment is being commissioned, shared or transferred?  

What questions do the CQC ask registered managers?

According to manager forums, some of the recent questions managers have been asked include:

• How did you find this role?
• What was the induction process like and what training have you received?  
• How long have you been working here?
• How did you find this role?
• What do you like/dislike about the role?
• Do you have any concerns?  
• How does management treat you and your colleagues?
• Do you feel supported?
• What support do you have out of hours.  
• How can people make a complaint? – staff have been asked to describe what this entails.
• What is the company’s whistleblowing policy? – staff have been asked to describe it.
• When was your last supervision, and what was the frequency?  
• Can you provide examples of how you promote someone’s dignity, privacy and choices?
• How do you respond to changes in someone’s health condition?
• How do you adhere to infection control protocols?
• Can you demonstrate your understanding of hand hygiene?
• How do you support people’s social and recreational needs?

Conclusion

It is worth remembering that it is not just care staff that the regulator could speak to, but also maintenance, domestic, directors, CEOs, deputies, volunteers, and any other role you employ.  

The regulator will focus more time on the Nominated Individual, as well, so it is important that everyone working within your organisation is prepped and ready. Remember, the inspector is there to do their job, and there is nothing you or your team should fear about them coming into your service.